Anya P G F Vieira-Meyer1,2, Maria de Fatima A S Machado3, Fabiane A Gubert4, Ana Patricia P Morais5, Yana Paula Sampaio6, Maria Vieira L Saintrain7, Drew Cameron8, Sarah Reynolds8, Tala Katarina Ram8, Lia Fernald8. 1. Family Health Master Program, Fundação Oswaldo Cruz (FIOCRUZ), Fortaleza. 2. Faculty of Dentistry, Centro Universitário Christus (Unichristus), Fortaleza. 3. Departamento de Saúde, Centro de Ciências da Saúde, Universidade Regional do Cariri, Crato, Ceará. 4. Department of Nursing, Federal University of Ceará (UFC), Fortaleza, Ceará. 5. Universidade Estadual do Ceará (UECE), Fortaleza, Ceará. 6. Faculdade de Medicina de Juazeiro (FMJ), Juazeiro do Norte, Ceará. 7. Public Health Program, Universidade de Fortaleza (UNIFOR), Fortaleza, Brazil. 8. School of Public Health, University of California, Berkeley, CA, USA.
Abstract
BACKGROUND: Brazil is the most populous country with a public, universal and free health care system. The National Program for Access and Quality Improvement in Primary Care (PMAQ) was created to improve the quality of primary health care (PHC). OBJECTIVE: To evaluated whether progress generally has been made within Brazil's PHC since PMAQ implementation, and if changes occurred uniformly in the country, while also identifying municipal characteristics that may have influenced the improvement. METHODS: This is an observational study using data from PMAQ external evaluation (2012 and 2014), a 1200-item survey used to evaluate Brazilian PHC quality. After confirming the groupings of items using factor analysis, we created 23 composed indexes (CIs) related to infrastructure and work process. RESULTS: On average, the large majority of CIs showed improvements between 2012 and 2014. Region and city size moderated changes in the PHC indices differently. Overall, there were better improvements in infrastructure in the Northeast compared with other country regions, and in smaller cities (10 000-20 000 people). Infrastructure indices appear to have improved equitably across the country. Work process improvements varied with city size and region. CONCLUSION: Despite similar support of PMAQ across the country, improvements are not predictable nor homogeneous. Non-uniform improvements were seen in Brazil's PHC. Though we do not directly evaluate the effectiveness of the PMAQ (financial reward) method, these initial findings suggest that it is a potentially useful tool to improve health systems, but additional support may be needed in regions that lag behind in quality improvements.
BACKGROUND: Brazil is the most populous country with a public, universal and free health care system. The National Program for Access and Quality Improvement in Primary Care (PMAQ) was created to improve the quality of primary health care (PHC). OBJECTIVE: To evaluated whether progress generally has been made within Brazil's PHC since PMAQ implementation, and if changes occurred uniformly in the country, while also identifying municipal characteristics that may have influenced the improvement. METHODS: This is an observational study using data from PMAQ external evaluation (2012 and 2014), a 1200-item survey used to evaluate Brazilian PHC quality. After confirming the groupings of items using factor analysis, we created 23 composed indexes (CIs) related to infrastructure and work process. RESULTS: On average, the large majority of CIs showed improvements between 2012 and 2014. Region and city size moderated changes in the PHC indices differently. Overall, there were better improvements in infrastructure in the Northeast compared with other country regions, and in smaller cities (10 000-20 000 people). Infrastructure indices appear to have improved equitably across the country. Work process improvements varied with city size and region. CONCLUSION: Despite similar support of PMAQ across the country, improvements are not predictable nor homogeneous. Non-uniform improvements were seen in Brazil's PHC. Though we do not directly evaluate the effectiveness of the PMAQ (financial reward) method, these initial findings suggest that it is a potentially useful tool to improve health systems, but additional support may be needed in regions that lag behind in quality improvements.
Authors: Anya Pimentel Gomes Fernandes Vieira-Meyer; Ana Patrícia Pereira Morais; José Maria Ximenes Guimarães; Isabella Lima Barbosa Campelo; Neiva Francenely Cunha Vieira; Maria de Fátima Antero Sousa Machado; Paula Sacha Frota Nogueira; Sharmênia de Araújo Soares Nuto; Roberto Wagner Júnior Freire de Freitas Journal: Rev Saude Publica Date: 2020-06-10 Impact factor: 2.106